Focus on the Big Picture

I still remember my first patient in medical school as if it was yesterday.

It was the summer of 2000 when I started my surgical clerkship in a large county hospital.  That place had anything and everything one could possible imagine with respect to the spectrum of disease and humanity.  Young, old, a ton of homeless patients, drug and alcohol addicts, psychiatric illness galore…  The Emergency Room was more like a zoo when one considers the noises and the smells there…

So with this context in mind, imagine my first week on the surgical rotation.  My first patient was a homeless 60-year-old man who smoked 1-2 packs per day for about 45 years.  As a result he had severe vascular disease and was in the process of losing his leg to dry gangrene due to lack of circulation.  To make the problem worse, he became addicted to narcotic pain medicine while in the hospital.

I walked into his room one day on rounds to examine him, and irritated he said to leave him alone because he needs to focus.  Focus on what?

Then I noticed he was holding his Morphine PCA (patient controlled analgesia) button in his hand and looking at the medication pump screen intensely.  He figured out the PCA formula down to the last detail, and was trying to maximize the amount of narcotic he would receive from the machine.

He figured out that the machine would dispense a morphine bolus only after a 10 minute lock out.  Furthermore, as a safety check, the machine was programmed to dispense a certain maximum amount each hour regardless of the lockout intervals and the number of times the patient pushes the button.  He learned the way the machine worked, and when I walked in he knew he had about 5 minutes before it would respond to another push.

He was so focused on counting down the minutes and seconds to the expiration of the lockout interval that he would not even talk to me about the grand picture, which was the upcoming surgery to fix the problem in his leg.

This world and the sin around us work in a similar way.

Those who have not found God are so entrenched into the world and into sin that they cannot grasp the big picture.  They would rather focus on the next vain pleasure than step back and realize that they are on the road to perdition.

Consider what Paul writes in Romans 6:23 about the outcome of being a slave to sin:

“For the wages of sin is death, but the free gift of God is eternal life in Christ Jesus our Lord”

Focus on sin leads to death.

Salvation by the free gift of God leads to eternal life in Jesus.

End-of-Life Comfort Care is not Euthanasia

Euthanasia or physician induced suicide is drastically different from comfort care in the final days or weeks of someone’s life.

Here are some clarifications:

Euthanasia – the intentional physician induced killing of a person for his/her alleged benefit.  The physician ensures that the act is not “botched,” and is typically done by physician or nurse-administered lethal injection.  This is currently legal in a some countries but it is illegal in all the States in the Union.

Physician aid in Dying (PAD) or assisted suicide – here the physician prescribes the lethal injection while the patient self-administers it.  Some form of this practice is legal in Oregon, Washington and Montana.

End-of-Life Comfort Care or Hospice Care – the palliation or alleviation of symptoms at the end of life for terminally ill patients.  The physical goal here is to treat pain and respiratory distress using narcotics which ease the dying process.  Emotional and spiritual care are typically a part of hospice as well.

I have made the argument (here) that euthanasia (and suicide assisted in any way) is a crime against God because we do not have the right to give or take life.  But it is important to realize that comfort care given to a patient who has arrived in the final stages of illness is NOT an assisted suicide.  Comfort care is a compassionate act aimed at making physical and emotional pain manageable in the last few hours to weeks of life.

What about administering narcotics like morphine or fentanyl to patients with end-stage illness?  Doesn’t that directly lead to the patient’s demise?

The answer is NO.  They help ease the patient’s passing, and they are not meant to actually kill him.  The disease pathology ultimately causes the patient’s demise.

As pneumonia or airway complications are usually the final road to passing in many terminally ill patients, the narcotics used in comfort care also help in alleviating the respiratory distress that can become a problem in the last day or two of life.

Anyone who watched a loved one pass away from terminal illness can probably attest that comfort care is almost a polar opposite to euthanasia.

Our God is a God of love, mercy and compassion.  His children must demonstrate and practice these communicable attributes we have received from Him. Compassionate care for terminally ill is in line with these godly attributes.  I do not think it is a stretch to apply this verse to the goal of comfort care at the end of our patients’ lives:

“3 Praise be to the God and Father of our Lord Jesus Christ, the Father of compassion and the God of all comfort, 4 who comforts us in all our troubles, so that we can comfort those in any trouble with the comfort we ourselves have received from God.” 2 Cor 1:3-4